Unfractionated heparin infusion for treatment of venous thromboembolism based on actual body weight without dose capping
- 18 October 2019
- journal article
- research article
- Published by SAGE Publications in Vascular Medicine
- Vol. 25 (1), 47-54
- https://doi.org/10.1177/1358863x19875813
Abstract
Controversy exists regarding the use of dose capping of weight-based unfractionated heparin (UFH) infusions in obese and morbidly obese patients. The primary objective of this study was to compare time to first therapeutic activated partial thromboplastin time (aPTT) in hospitalized patients receiving UFH for acute venous thromboembolism (VTE) among three body mass index (BMI) cohorts: non-obese (< 30 kg/m2), obese (30–39.9 kg/m2), and morbidly obese (⩾ 40 kg/m2). In this single-center, retrospective cohort study, patients were included if they ⩾ 18 years of age, had a documented VTE, and were on an infusion of UFH for at least 24 hours. Weight-based UFH doses were calculated using actual body weight. A total of 423 patients met the inclusion criteria, with 230 (54.4%), 146 (34.5%), and 47 (11.1%) patients in the non-obese, obese, and morbidly obese cohorts, respectively. Median times to therapeutic aPTT were 16.4, 16.6, and 17.1 hours in each cohort. Within 24 hours, the cumulative incidence rates for therapeutic aPTT were 70.7% for the non-obese group, 69.9% for the obese group, and 61.7% for the morbidly obese group (obese vs non-obese: HR = 1.02, 95% CI: 0.82–1.26, p = 0.88; morbidly obese vs non-obese: HR = 0.87, 95% CI: 0.62–1.21, p = 0.41). There was no significant difference in major bleeding events between BMI groups (obese vs non-obese, p = 0.91; morbidly obese vs non-obese, p = 0.98). Based on our study, heparin dosing based on actual body weight without a dose cap is safe and effective.Keywords
This publication has 26 references indexed in Scilit:
- Recurrent venous thromboembolism while on anticoagulant therapyBlood Reviews, 2012
- Accuracy of hospital morbidity data and the performance of comorbidity scores as predictors of mortalityJournal of Clinical Epidemiology, 2012
- Dosing of Unfractionated Heparin in Obese Patients with Venous ThromboembolismJournal of General Internal Medicine, 2010
- Effect of Body Mass Index on Bleeding Frequency and Activated Partial Thromboplastin Time in Weight-Based Dosing of Unfractionated Heparin: A Retrospective Cohort StudyMayo Clinic Proceedings, 2009
- Limitations of a standardized weight-based nomogram for heparin dosing in patients with morbid obesitySurgery for Obesity and Related Diseases, 2008
- Research electronic data capture (REDCap)—A metadata-driven methodology and workflow process for providing translational research informatics supportJournal of Biomedical Informatics, 2008
- Estimating Blood Volume in Obese and Morbidly Obese PatientsObesity Surgery, 2006
- Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non‐surgical patientsJournal of Thrombosis and Haemostasis, 2005
- Continuous Intravenous Heparin Compared with Intermittent Subcutaneous Heparin in the Initial Treatment of Proximal-Vein ThrombosisNew England Journal of Medicine, 1986
- Clinical Pharmacokinetics of HeparinClinical Pharmacokinetics, 1980